Paraurethral cyst: signs, treatment with surgery

Women of childbearing age experience various diseases, some of them are very common, and some are rare, but can potentially interfere with the way of life. One of them is the formation of cysts in the reproductive organs. Cysts are common in women, but some cysts are rarely found in men in the urethra. This condition is also known as the para-urethral cyst. Let's look at all the details.

[1], [2], [3], [4], [5], [6]

Epidemiology

Statistics of pathology suggest that paraurethral cysts usually occur between the ages of 20 and 60 in about 1-6% of women. Urethral diverticula account for approximately 80% of paraurethral cystic lesions. Because of their usually asymptomatic nature, paraurethral cysts are rarely diagnosed and treated, and reports available in databases are relatively inadequate. Patients most often consult a doctor during the third and fourth decade of life because of recurring infections and urinary disorders of unknown cause.

[7], [8], [9], [10], [11], [12], [13], [14]

Causes of the paraurethral cyst

The paraurethral cyst in women is classified primarily as acquired or congenital, although a clear distinction is often difficult. This is the main cause of the development of pathology.

The female reproductive system develops from Mueller wires. Incorrect absorption of Mueller content can lead to stagnant cysts. Most congenital vaginal cysts come from the Mueller ducts (they are the second most frequent vaginal cysts after acquired squamous cell cysts.) They are most often located around the vagina in the anterior or anterior vaginal trunk. Congenital para-urethral cysts arise from various embryological components and rudimentary vaginal and female urethral remains. To understand the mechanism of cyst formation, you need to know some features of embryology, and to understand where this cyst can come from. The vagina originates from the paramune-mesenteric (Mullerian) duct, the mesophilic (Wolffian) duct and the urogenital sinus. Most vaginal cysts have the origin of the Mullerian duct. They usually secrete mucus and can be symptomatic, especially in older patients.

Paraurethral glands and ducts that are omitted in the female urethra are rudimentary analogues of the prostate gland in men. There are 6-30 paraurethral ducts. The two largest channels are usually called Skene channels. Paraurethral cysts originate from the Skene canal. These glands secrete a small amount of mucoid material, which serves to lubricate the urethral passage during coition.

It performs many important functions for women and men:

1. Secretes the fluid to lubricate the urethral opening.
2. Secreted fluids contain antimicrobial properties to protect the urinary tract from infection.
3. It also secrete ejaculate, known as prostate-specific antigen, which is found in men. Prostate-specific antigen is a type of protein produced by prostate epithelial cells.

And the cyst is formed when the outflow of fluid from the gland is broken and swelling occurs. This cyst is lined with a transitional epithelium. However, some of the paraurethral ducts opening distally near the external passage are lined with stratified squamous epithelium. Cysts derived from persistent mesenteric (Gartner's) ducts are lined with a cubic or low columnar epithelium and do not secrete mucus. They are usually located in the anterolateral wall of the vagina and are usually asymptomatic.

Microscopically, cysts are usually lined with stratified squamous epithelium and may contain a caseous or purulent material.

Acquired cysts are the most common cystic lesion of the vagina, which is often considered secondary to trauma due to labor or caused by iatrogenic surgical trauma, such as episiotomy. When the channel in these glands clogs, the liquid begins to accumulate, which leads to the formation of cysts. The causes of the violation of outflow of fluid from the cyst can be not only trauma, but also pregnancy, a persistent persistent infection.

[15], [16]

Risk factors

Risk factors are not limited only by age. Currently, there are no specific risk factors for the formation of Skene canal cyst.

It is important to note that the presence of a risk factor does not mean that a person will fall ill. The risk factor increases the likelihood of getting a condition compared to a person without risk factors.

The paraurethral cyst in men is rare, because in men these glands are poorly developed, and their function is replaced by the prostate. The reason for the formation of cysts in men is unclear, but more often it happens after the first sexual experience in those in which the iron is not completely reduced. An important factor in the development of inflammation is infection.

[17], [18], [19], [20], [21]

Pathogenesis

The pathogenesis of further complications is that this condition causes an increase and swelling of these glands, and in the worst case, the cyst can turn into a painless abscess that can be formed due to bacteria or pathogens. The main bacteria responsible for this are more often Chlamydia and N. Gonorrhea. Opportunistic infections in patients suffering from HIV can also cause this type of infection.

Cysts of paraurethral glands are rarely found in the young age group. As a rule, paraurethral cysts are formed in adult women (middle and elderly women). In rare cases, this condition is observed in infants.

[22], [23], [24], [25], [26]

Symptoms of the paraurethral cyst

The first symptoms of the disease with small cysts can be in the form of frequent infections of the urinary tract. This is because the cyst can be a source of infection, which is difficult to identify.

Most of the time, the glands will have a diameter of less than 1 centimeter and will be asymptomatic. When patients start to notice manifestations, the cyst is usually more than 1 centimeter. Symptoms that accompany the appearance of paraurethral cysts include: the presence of a palpable, sometimes visible thickening or nodules in the vagina or external urethra. Also often there may be pain in the area of female genital organs, dysuria, dyspuria and a violation of the flow of urine. Other symptoms of cysts can include painful sex, discomfort when sitting and walking. Cysts larger size can block the urethra, causing painful urination.

If this cyst progresses without treatment, it will develop further into an abscess, which can become much more difficult for patients. Some women may develop fever as a result of the formation of an abscess in the gland.

Can I get pregnant if I have a paraurethral cyst? This question is of interest to many, since pathology is quite common. The gland itself does not interfere with normal fertilization. But it can be a hidden source of infection, which can be dangerous for the child. During childbirth, a large cyst may interfere with the normal passage of the fetus through the birth canal. Therefore, pregnant with this pathology is not recommended, because there may be complications.

Stages

Stages of cyst development are an increase in size, and the final stage can be considered the formation of an abscess. Types of cysts are determined histologically, and this is indicated by the cellular layer that lining the cyst from the inside. This is not very important for treatment, but it can have prognostic value in terms of dysplasia development in the future.

[27], [28], [29], [30], [31]

Complications and consequences

Consequences and complications of cysts can be the following:

1. continuous and recurrent cysts;
2. repetition of abscesses, which will need to be treated on an ongoing basis;
3. damage to muscles, vital nerves and blood vessels during surgery;
4. Post-surgical infection on the wound site is a potential complication.

When the para-urethral cyst has burst, everything depends on the contents in it. If there is a simple transudate, then there should be no consequences and simple preventive antibacterial treatment can be used. If the cyst contained pus, then it is necessary to sanitize the cavity of the cyst, since this can become a source of infection and complicate the development of inflammation of the genital organs.

[32], [33], [34], [35], [36], [37]

Diagnostics of the paraurethral cyst

Diagnosis of pathology should begin with the collection of complaints. Physical examination allows you to determine the changes in 63% of cases. There is a change in the wall of the vagina, which can cause purulent or bleeding secretion from the urethra. During pelvic examination, doctors can usually feel cysts or abscesses if they are large enough to cause symptoms. The doctor may also determine visually the rounded cyst of the canal when viewed.

Instrumental diagnosis is carried out to clarify the diagnosis. For more information, ultrasonography is often used. Cystoscopy can also be performed with a flexible inspection tube to examine the bladder.

Another option may include a fine needle biopsy, which involves inserting a fine needle into the cyst and extracting its contents. Then this sample will be sent for laboratory testing. For women aged 40 years and older, a biopsy will also help determine the presence of any cancer cells. Such tests allow you to determine the type of cyst, as well as determine the tactics of treatment.

Many clinical conditions may have similar signs and symptoms. Your doctor may perform additional tests to exclude other clinical conditions in order to arrive at a final diagnosis.

[38], [39], [40], [41], [42]

Differential diagnosis

Differential diagnostics of the paraurethral cyst should be performed with the following pathology: ureterocele; cyst of the Gartner channel; cyst of the Müllerian residue; cysts of the inclusion of the vaginal wall; urethral or vaginal neoplasm; prolapse of the urethra; diverticulum of the urethra.

Ureterocele is a congenital anomaly that involves a cystic dilatation of the terminal portion of the ureter, often associated with a stenotic opening. About 90% of ectopic ureterocele are associated with the upper part of the duplex collection system and 10% with one system. In women, ureterocele can appear after infections of the genitourinary system. The dropping ureterocele is a smooth, round, interplasma mass of different size and color. The main differential sign of ureterocele, in contrast to cyst, is the analysis of aspiration material. If the aspirated liquid from the mass is urine, the diagnosis will be accurately established.

The Gartner cyst is lined with a cubic or low columnar epithelium and does not secrete mucus. They are located on the anterolateral areas of the vagina, lateral in the upper and anterior part of the lower part. Usually cysts are single, can be small, or they can become so large as to bulge out of the vagina. The biopsy analysis is also the main differential sign of such a cyst.

Urethral or vaginal neoplasm: the paraurethral masses may be hard or cystic. Solid masses usually manifest themselves in a physical examination and include fibroma, leiomyoma, neurofibroma, lipoma, myoblastoma, hemangioblastoma, lymphangioma and their malignant analogues. Most patients are more than 50 years old. Tumors can have various manifestations: papillary growth in the urethra, as a soft, friable, fungal mass, ulcerative lesions or as a submucosal mass, creating a compaction of the anterior wall of the vagina. A pelvic examination (under anesthesia) in combination with cystourethroscopy and biopsy of the lesion is required. At the initial stages of differential diagnostics of the paraurethral cyst and neoplasm, the main thing is the result of a biopsy - if the cells have abnormal or atypical signs, this indicates a neoplasm.

[43], [44], [45], [46]

Treatment of the paraurethral cyst

Treatment will depend on various factors, such as symptoms, cyst size or cyst infection. In most cases, when cysts are small and do not cause any symptoms, you will not need any treatment. In other cases, the following treatment options are available.

Drug treatment is the use of certain drugs.

1. Iodinol with a paraurethral cyst is used as an antiseptic. The composition of the drug includes an ion of iodine and alcohol. These are strong antibacterial drugs with a pronounced antiseptic agent. Use drugs externally. Method of application - you can use a lubricant solution three to four times a day, which is not very convenient to do. Therefore, you can make baths or syringings, diluting the drug with water. Side effects can be in the form of a strong allergic reaction to iodine. If the concentration of alcohol is high, there may be burning or itching.
2. When infection of the cyst occurs as a result of bacteria, antibiotic therapy can be used. Your doctor may prescribe antibiotics, such as penicillin. Amoxiclav is an antibiotic that is protected from destruction by bacteria. The drug may be the first line antibiotic. Dosage - 500 milligrams three times a day for at least five days. Side effects on this group of antibiotics can be in the form of severe allergic reactions or stool disorders.
3. Alternative treatment is the use of methods at home, in which you must sit in a warm bath filled with water, about 15-20 minutes per session. This should be repeated several times a day. Chlorhexidine may be added to the solution. If carried out for 3-4 days, the cyst may burst and cause fluid leakage. This method can be offered to a patient with minor cysts.
4. Use apple cider vinegar to try and reduce the size of vaginal cysts. Either make a bath and add 1 tablespoon of vinegar, or you can make a cotton swab and use it. Apply an impregnated cotton ball or swab directly to the cyst and hold it there for 30 minutes twice a day until you notice that the swelling will decrease. While vinegar is a popular home remedy, scientists do not recommend using vinegar as a medicine.
5. Use a warm compress. Fill the bottle with hot water and wrap it with a clean towel. Place it in front of the cyst to provide some relief of pain. You can also try to apply a heat pack. You can also dip a flannel or cotton cloth in hot water, squeeze out water and apply it directly to the cyst.
6. Apply a mixture of aloe vera. Mix 1 - 2 tablespoons of aloe vera gel with 1/4 to 1/2 teaspoons of turmeric powder. Stir until the mixture forms a paste. Use a cotton swab to apply the mixture on the cyst. Leave it for 20-30 minutes once a day. Do not rinse or clean the paste. Studies have shown that turmeric is an anti-inflammatory drug that can reduce irritation caused by vaginal cysts.

Vitamins can be used, but physiotherapy treatment only on indications in the postoperative period. You can use iontophoresis with an antibiotic for better healing of the scar.

Surgical treatment - this option is designed for women with large cysts or abscess. Removal of the paraurethral cyst or excision of the para-urethral cyst is performed when there is a risk of malignancy, or its dimensions interfere with daily life. The doctor will make a small incision in the cyst and extract the contents there. The postoperative period implies the appointment of antibiotics if there is an infection in the cyst or an abscess caused by bacteria, as well as to prevent complications. The temperature after removal of the paraurethral cyst can be with the development of infection and secondary infection, so you need to carefully monitor this condition.

Marsupialization. This method is usually performed under local anesthesia. It is used in cases where cysts often recur or when surgical removal is undesirable. The doctor will first give you a local anesthetic. Then a cyst or an abscess will be incised and drainage will be placed on each side. The catheter will be placed in the hole to ensure drainage of the fluid. It will be a small permanent hole so that the liquid can flow freely. Postoperative care is important: the minimum level of activity should be provided until the surgical wound heals. Important is the follow-up care with regular screening and checks. Most women after the drainage feel relieved. At subsequent inspections a year after the procedure, virtually all patients do not have any additional symptoms of discomfort during urination, and there is no visual evidence of the cyst.

Prevention

Prevention of the formation of paraurethral glands is slightly complicated, since there are no direct causes of the development of this pathology.

There are no specific ways to prevent the appearance of a cyst. However, after taking certain measures, the risk of further complications can be reduced:

1. The practice of safe sex (for example, the use of condoms).
2. Always keep a good personal hygiene.
3. Drink plenty of water and other liquids (such as fruit juices).
4. It is recommended to have a medical examination at regular intervals using scans and physical examinations (as recommended by the doctor).

[47], [48], [49], [50]

Forecast

The prognosis of the paraurethral cyst is usually favorable with proper treatment. Most women feel relieved after the drainage of the abscess. In very rare cases, women may experience recurrent cysts and abscesses, which may require treatment through the surgical procedure of marsupialization.

The paraurethral cyst is an unpleasant pathology today, which brings a lot of discomfort to both women and men. Early diagnosis makes it possible to conduct effective treatment and improve the prognosis. Methods of treatment are limited to individual cysts, but the main thing is preventive measures.

[51], [52]